Medical Aids and Appliances Provision

Questions (63)

Jonathan O'Brien

Question:

63. Deputy Jonathan O'Brien asked the Minister for Health the extent of, and the actions he will take to reverse, the decision of Health Service Executive services to refuse to provide incontinence pads to persons in need, including in serious health circumstances in some cases forcing medical card holders to buy a full box at a cost of €44 and the refusal to provide appropriate gloves for the safe insertion of catheters; and if he will make a statement on the matter. [48960/12]

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Written answers (Question to Health)

I have asked the Health Service Executive to investigate this matter and I will respond to the Deputy as soon as possible.

Health Services Staff Issues

Questions (64)

Jonathan O'Brien

Question:

64. Deputy Jonathan O'Brien asked the Minister for Health the annual outlay for personal assistants in each of the years 2008, 2009, 2010 and 2011 and the anticipated spend for same in 2012; if he will confirm that there will be no cuts to services for persons dependent on personal assistants; and if he will make a statement on the matter. [48961/12]

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Written answers (Question to Health)

The Health Service Executive (HSE) provides a range of assisted living services, including Personal Assistant services, to support individuals to maximise their capacity to live full and independent lives. As detailed in the HSE National Service Plan 2012, due to regional variations in service developments and budget allocations, data collected under the performance indicators process has become increasingly unreliable. The National Disability Governance Group is currently undertaking a comprehensive review of the performance indicator process. As a result, reliable data for 2008-2010 cannot be provided.

In 2011, a total of 1.68 million personal assistant/home support hours were provided to persons with physical and/or sensory disability. In 2012 the target for PA hours is 1.64 million hours. It is anticipated that the outturn of 1.68 million in 2011 and the 2012 target will both be exceeded. In 2011, an additional 16,000 hours PA/Home Support hours were provided as a result of €10 million demographic funding allocated to Disability Services. It was not possible to provide additional funding in 2012 for this purpose.

Although the funding allocated to disability services in 2012 was reduced by 3.7%, the HSE's main aim was to minimize the impact this would have on service users and their families as much as possible. Service efficiencies around the provision of Personal Assistant services are currently being achieved through a process of negotiation with service providers around the unit cost of providing the service, rather than reducing the number of PA hours. In this context, the National Disability Unit is engaging with each HSE region to identify models and approaches in place pertaining to Personal Assistant and Home Support Services as well as cost, such as hourly and daily rates, involved in providing services. This process will identify the precise nature of the services available with the intent of identifying agreed models of service delivery.

Pending completion of the national estimates, budgetary and service planning process of 2013, it is not possible to predict the service levels to be provided next year.

Services for People with Disabilities

Questions (65)

Michael McGrath

Question:

65. Deputy Michael McGrath asked the Minister for Health the action he is taking to ensure that school leavers with mental health disabilities who will leave school in 2013 will have suitable placements and services available to them after leaving school; and if he will make a statement on the matter. [48930/12]

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Written answers (Question to Health)

Day services for adults with disabilities and mental health issues provide a network of support for over 25,000 people who have a wide spectrum of need, ranging from those with severe and profound disabilities who are likely to need long-term specialist service provision to people with lower support needs and greater potential for community participation and inclusion. The HSE, through its Occupational Guidance Service, works with schools, service providers, service users and families to identify the needs of young people with disabilities who are due to complete their second level education. The aim is to address the needs of individuals in the following ways:

- Health-funded rehabilitative (life skills) training (RT);

- Health-funded day services;

- FÁS-funded vocational training;

- Approval to extend education placement for a specified time.

The demand for services for school-leavers continues to grow. In 2012, almost 700 school-leavers required RT places or day services and the position in 2013 is expected to be similar. Budgetary constraints and the moratorium on staff recruitment give rise to challenges in service provision. In addition the physical capacity to provide further services may not be present in all agencies. However both the voluntary sector and the HSE are committed to the best use of available resources in a creative and flexible manner so as to be as responsive as possible to the needs of this cohort. While the HSE makes every effort to provide day services or RT places to school-leavers with special needs, this has always been dependant on the availability and location of appropriate places coupled with the needs of the individual school-leaver. The HSE is currently reviewing the outcomes for 2012 school-leavers in terms of placements achieved and scoping out the likely requirements for 2013.

There is evidence that an accelerated move towards a new model of individualised, person-centred service provision in the community can help to achieve efficiencies, particularly in relation to services for those with mild or moderate intellectual disability. The HSE has established an implementation project team to oversee the implementation of the recommendations in the report of the National Working Group for the Review of HSE-funded Adult y Services. The report, published in February 2012, titled 'New Directions', proposes that day services in the future take the form of a menu of 12 individualised, outcome-focussed supports which will provide adults with disabilities with the support necessary to live a life of their choosing in accordance with their own wishes, aspirations and needs. The guiding principle for the future is that supports will be tailored to individual need and will be flexible, responsive and person-centred.

Health Insurance Prices

Questions (66)

Barry Cowen

Question:

66. Deputy Barry Cowen asked the Minister for Health his views on the latest increase in VHI prices; and if he will make a statement on the matter. [48939/12]

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Written answers (Question to Health)

The Deputy is referring to the recent VHI announcement that it is to increase prices by between 2%-3% across most of its plans with effect from 22 November 2012.

VHI sets its own premiums and I am not legally empowered to direct the VHI in any way in relation to its prices. However, the Government is committed to keeping down the cost of health insurance so that it is affordable for as many people as possible.

I have consistently raised the issue of costs with VHI and with the other health insurers and I am determined to address costs in the sector in the interests of consumers.

The VHI has the great majority of less healthy customers in the health insurance market, and as a result, pays out by far the highest proportion of claims in the market. People are living longer with chronic illnesses and this in turn is contributing to increased demand and utilisation of healthcare services.

The Government is committed to keeping down the cost of health insurance so that it is affordable for as many people as possible, and is committed to protecting community rating, whereby everyone pays the same price for the same health insurance product, irrespective of age or gender. A significant degree of support for the cost of health insurance claims by older people is provided for through the Interim Risk Equalisation Scheme which has been in place since 2009. The Programme for Government contains a commitment to put a permanent scheme of risk equalisation in place. This is a key requirement for the existing Private Health Insurance market and is designed to keep health insurance affordable for older persons and to maintain the stability of the market. The Government published the Health Insurance (Amendment) Bill 2012 to give effect to a new Risk Equalisation Scheme to be applied from 1 January 2013 which I will shortly bring before the Oireachtas.

Health Screening Programmes

Questions (67)

Charlie McConalogue

Question:

67. Deputy Charlie McConalogue asked the Minister for Health when BreastCheck will be extended to women aged 65 to 69 years; and if he will make a statement on the matter. [48929/12]

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Written answers (Question to Health)

The BreastCheck Programme provides free mammograms to all women aged 50-64. The Programme for Government includes the extension of Breastcheck to women in the 65-69 age group, in keeping with EU Guidelines on effective screening for breast cancer.

The main priority for the HSE's National Cancer Screening Service (NCSS) at present is to maximise national uptake in the 50-64 year age cohort.

The extension of the BreastCheck programme has been listed as a priority in the HSE's 3 year Corporate Plan (2012 -2015). The HSE's National Cancer Control Programme is examining how it can extend the programme to 65-69 year olds. A review of the BreastCheck screening process, which will conclude shortly, should help to inform how greater efficiencies may be achieved within the Programme.

In the meantime women of any age who have concerns about breast cancer should seek the advice of their GP who will, if appropriate, refer them to the symptomatic breast services in one of the eight designated specialist cancer centres.

Hospital Services

Questions (68)

Thomas P. Broughan

Question:

68. Deputy Thomas P. Broughan asked the Minister for Health if he will address the service provision on the northside of Dublin for citizens with cystic fibrosis in view of the fact that there are only four dedicated rooms for patients with cystic fibrosis in Beaumont Hospital and five cystic fibrosis dedicated beds in Temple Street for children and young persons with cystic fibrosis; and if he will make a statement on the matter. [48748/12]

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Written answers (Question to Health)

I am acutely aware of the challenges that people with cystic fibrosis (CF), and their families, face in managing their condition. I fully acknowledge the need for and support the provision of dedicated accommodation in an environment which allows appropriate isolation for improved infection control.

Beaumont Hospital is one of the largest adult centres in Ireland, providing specialist treatment and services to adults with CF. A new outpatient cystic fibrosis unit was opened in Beaumont Hospital in November 2010. This CF dedicated centre facilitates the delivery of a comprehensive range of services by multidisciplinary teams. These services include consultations with doctors and nurses and the provision of treatments, which might otherwise have required hospitalisation, assessment of pulmonary function, physiotherapy, dietetics and psychology. This unit has a significant benefit for patients by having all services provided in a purpose-built facility.

The building includes consultation and therapy rooms with air filtration units, which allow for twelve air changes per hour, approximately three times the average rate in a normal room. This has significant benefit in reducing the time needed between patients for infection control purposes, which is particularly important for people with CF.

While all appointments have to be scheduled, the new ambulatory day case unit facilitates patient access to essential services. Along with priority access to four en-suite in-patient rooms on St. Paul’s Ward, it means that for Beaumont’s CF patients, admission as an in-patient via the Emergency Department should now be a rare occurrence. This CF unit in Beaumont also contributes to the extensive research activities into CF already well established in Beaumont, principally in collaboration with the RCSI.

A new dedicated Respiratory and CF unit was opened in Temple Street in June 2010 providing state of the art facilities for children with respiratory disorders, their families and staff. It includes a lung function laboratory with the most up to date equipment, spacious patient treatment rooms and outpatient clinic rooms. The entire unit is fitted with a sophisticated air filtration system. This unit serves as a focus for patient care including scheduled outpatient clinics, daily walk in CF clinics, initiation of intravenous antibiotics, upsizing of gastrostomy tubes, family education and support sessions and multi disciplinary team meetings.

The National Newborn Bloodspot Screening Laboratory is also located in Temple Street. The new unit facilitates care of the children diagnosed with Cystic Fibrosis under the newborn CF screening programme. I am fully aware of the challenges facing CF patients and of the need to support these patients and their families. I am committed to providing the best possible health service and will continue to work with the HSE to ensure the best possible outcomes for these patients.

Home Help Service Provision

Questions (69)

Niall Collins

Question:

69. Deputy Niall Collins asked the Minister for Health if reports that home helps in County Cork have been instructed that they can no longer do tasks such as housework, shopping or collecting medication for elderly and disabled patients are accurate; his views on such instructions; and if he will make a statement on the matter. [48938/12]

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Written answers (Question to Health)

As this is a service matter it has been referred to the Health Service Executive for direct reply.

Treatment Abroad Scheme

Questions (70)

Gerry Adams

Question:

70. Deputy Gerry Adams asked the Minister for Health if his attention has been drawn to new procedures for issuing Form E112, hospital treatment in another EU/EEA country, which involve now having an appointment with an Irish based consultant in advance of every foreign; that this requirement has caused some patients to miss and cancel appointments and caused unnecessary delays in patients accessing treatment; if he will investigate this situation; and if he will make a statement on the matter. [48978/12]

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Written answers (Question to Health)

The HSE operates a treatment abroad scheme, TAS, for persons entitled to treatment in another EU/EEA member state or Switzerland under EU Regulation 1408/71, as per the procedures set out in EU Regulation 574/72, and in accordance with Department of Health Guidelines. Within these governing EU Regulations and the Department of Health and Children's Guidelines, the TAS provides for the cost of approved treatments in another EU/EEA member state or Switzerland through the issue of form E112 (IE).

The TAS allows for an Irish based consultant to refer a patient that is normally resident in Ireland for treatment in another EU member state or Switzerland, where the treatment in question meets the following criteria:

(a) The application to refer a patient abroad has been assessed and a determination given before that patient goes abroad.

(b) Following clinical assessment, the referring consultant certifies the following:

- They recommend the patient be treated in another EU/EEA country or Switzerland;

- The treatment is medically necessary and will meet the patient's needs;

- The treatment is a proven form of medical treatment and is not experimental or test treatment;

- The treatment is in a recognised hospital or other institution and is under the control of a registered medical practitioner;

- The hospital outside the state will accept EU/EEA form E112 (IE).

The procedures for applying for treatment under the TAS scheme have not altered. Under the TAS regulations, each appointment abroad is considered as an episode of care and the issuing of an E112 is specific to the application which has been approved. When an episode of care is complete, the patient immediately returns to the care of the Irish based referring consultant. Should the Irish based referring consultant deem that further episodes of care are necessary, he/she will advise the patient and the patient will complete a further E112 in conjunction with the consultant. All applications to the TAS are independently assessed by the HSE Health Intelligence Unit.

Care of the Elderly

Questions (71)

Michael Moynihan

Question:

71. Deputy Michael Moynihan asked the Minister for Health the action he will take on foot of the recent NESC report Quality and Standards in Human Services in Ireland; Residential Care for Older People; and if he will make a statement on the matter. [48947/12]

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Written answers (Question to Health)

The Deputy’s question refers to the report Quality and Standards in Human Services in Ireland; Residential Care for Older People,completed by the National Economic and Social Council (NESC).

This is one of a series of reports in a NESC project which looks at how quality processes, standards and regulations contribute to continuous improvement in delivery of services. The report examines the strengths, weaknesses and challenges presented by the regulatory framework that protects older people in nursing homes. It concludes that, overall, the standards are viewed positively and have increased the quality of and confidence in care provided in the nursing home sector. The Government remains committed to supporting older people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care where this is appropriate. This report is a valuable contribution that will inform our thinking in respect of developing policies and services in relation to long term care for older people. Their safety and well being is and will continue to be of paramount importance. Providing quality and safe care will always remain at the heart of any considerations.

Health Insurance Prices

Questions (72, 301)

Billy Kelleher

Question:

72. Deputy Billy Kelleher asked the Minister for Health the action he will take to tackle spiralling consumer prices in the private insurance market; his views on whether health insurers have the scope to reduce their costs significantly and that costs in recent times have been allowed to increase unnecessarily; and if he will make a statement on the matter. [48922/12]

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Billy Kelleher

Question:

301. Deputy Billy Kelleher asked the Minister for Health the measures he is taking to stop health insurance premiums spiralling out of control; and if he will make a statement on the matter. [49292/12]

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Written answers (Question to Health)

I propose to take Questions Nos. 72 and 301 together.

I am very aware that health insurance is becoming harder to afford, in particular for older people, as insurers increasingly tailor their insurance plans towards younger, healthier customers. The Government is committed to keeping down the cost of health insurance so that it is affordable for as many people as possible and is also strongly committed to protecting community rating, whereby older and less healthy customers should pay the same amount for the same cover as younger and healthier people.

To support the principle of community rating, the Programme for Government contains a commitment to put a permanent scheme of risk equalisation in place. This is a key requirement for the existing private health insurance market and is designed to keep health insurance affordable for older persons and to maintain the stability of the market. I was pleased, therefore, to recently publish the Health Insurance (Amendment) Bill, 2012 on 18 October, to give effect to a new Risk Equalisation Scheme (RES) to be applied from 1 January 2013. An effective and robust RES is required in the Irish private health insurance market in order to protect affordability for those who need it most.

There can be little doubt that price increases will make it more difficult for persons who hold private health insurance to renew their policies. I have consistently raised the issue of costs with health insurers and am determined to address costs in the sector in the interests of consumers. I will continue to focus strongly on this issue.

I am keen to explore all available measures to limit the costs related to health insurance. In February of this year I established the Health Insurance Consultative Forum which comprises representatives from the country's main health insurance companies, the Health Insurance Authority (HIA) and the Department of Health. This Forum has been established with a view to generating ideas which would help address health insurance costs. Its core focus is on identifying ways of addressing costs throughout the industry, whilst always respecting the requirements of competition law. Bilateral meetings have taken place with each insurer where they have brought forward their own ideas for cost savings in the market. The Forum will also give a voice to the insurers in the development of the new Universal Health Insurance model. I have also made it clear to the health insurers that I believe that significant savings can still be made, the effect of which can be to minimise the need for increases in premiums.

In this regard, VHI has commissioned consultants to carry out an external review of their claims. The review is nearing completion and will look at the opportunities and costs involved in possible reductions in utilisation that can be achieved by implementing appropriate utilisation management approaches.

I would also strongly advise consumers to shop around for the health insurance plan that best suits their needs. Consumers have a legal right to switch between or within insurers to get better value and to reduce their premium costs. The HIA provides information to consumers regarding their rights and also on health insurance plans and benefits. The HIA's website www.hia.ie has a useful plan comparison tool which assists in finding suitable and competitive health insurance plans.

National Dementia Strategy Publication

Questions (73)

Charlie McConalogue

Question:

73. Deputy Charlie McConalogue asked the Minister for Health the date on which the National Dementia Strategy will be published; and if he will make a statement on the matter. [48944/12]

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Written answers (Question to Health)

The Programme for Government gives a commitment to develop a National Strategy on Dementia by 2013 which will increase awareness, ensure early diagnosis and intervention, and enhance community based services for people living with this condition.

The first stage of the process was to assemble the research and evidence upon which the strategy will be developed. This was completed earlier this year and the report of the findings Creating Excellence in Dementia Care: a Research Review for Ireland’s National Dementia Strategy has been published. A guide for the general public, Future Dementia Care in Ireland: Sharing the Evidence to Mobilise Action was compiled to disseminate the report’s findings and to give a better understanding of dementia. Both the report and the guide are available at www.doh.ie .

A public consultation process which sought the views of interested parties, to help inform the development of the strategy concluded at the end of August and officials are currently examining the responses. Following on from this process a working group will be established to develop the strategy in 2013.

Home Help Service Provision

Questions (74)

Colm Keaveney

Question:

74. Deputy Colm Keaveney asked the Minister for Health the average spend per head of the population aged over 65 years in each county for the provision of home help hours; the account that was taken of the disparity in average spend in each county in determining the level of cuts to be made to the services; and if he will make a statement on the matter. [48746/12]

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Written answers (Question to Health)

As this is a service matter it has been referred to the Health Service Executive for direct reply.

Medicinal Products Availability

Questions (75)

John McGuinness

Question:

75. Deputy John McGuinness asked the Minister for Health if he will provide a full list of the medicines and patient products that have been withdrawn from the medical card and drug reimbursement schemes in 2012; and if he will make a statement on the matter. [48931/12]

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Written answers (Question to Health)

In the current financial environment the Health Service Executive (HSE) is facing a challenge to deliver services in a way that will minimise any adverse impact on patients and continue to protect, as far as possible, the most vulnerable citizens. Unfortunately, it has become necessary for the HSE to suspend certain products from its list of reimbursable items. These include glucosamine, omega-3 triglyceride products, orlistat, and gluten-free products.

Glucosamine is indicated for the management of symptoms of osteoarthritis. The National Centre for Pharmoeconomics (NCPE) have assessed the cost-effectiveness of glucosamine on two occasions and concluded that it did not offer value for money to the HSE. However, glucosamine products are available over the counter without prescriptions.

Omega-3 triglyceride products (e.g. Omacor) have been identified both nationally and internationally as not being cost effective or being of lesser benefit to patients. However, these products are also available over the counter without prescriptions, as is Orlistat.

Gluten-free products have become more widely available in supermarkets in recent years and tend to be significantly cheaper than products sold through community pharmacies. A Supplementary Welfare Allowance Adult Diet Supplement may be awarded by the Department of Social Protection to eligible persons. Persons wishing to apply for this allowance can do so by completing an application form which can be downloaded at the following link: http://www.welfare.ie/EN/Forms/Documents/swa9.pdf . Separate application forms are available for children. For persons who are not awarded a Diet Supplement, monies spent on gluten-free foods can be taken into account for tax purposes.

A full list of items available under the community drug schemes is available on the HSE's Primary Care Reimbursement Service website, www.pcrs.ie (choose 'List of Reimbursable Items'). In addition, the monthly updates (additions and deletions) to the product list are provided at the same location under 'Updates to the List of Reimbursable Items and High Tech Scheme List'.

Suicide Prevention

Questions (76)

Billy Kelleher

Question:

76. Deputy Billy Kelleher asked the Minister for Health his views on the verdict of the head of suicide prevention agency; Turn the Tide of Suicide, that the Government has worse than failed when it comes to tackling mental health and suicide issues; and if he will make a statement on the matter. [48942/12]

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Written answers (Question to Health)

I met recently with the representatives from the Turn the Tide of Suicide organisation and we had a very open and frank discussion around the area of suicide prevention.

Dealing with the current levels of suicide and deliberate self harm and reforming our mental health services in line with A Vision for Change are priorities for this Government. In this respect, a special allocation of €35m was announced in Budget 2012 for mental health which will be used primarily to further strengthen Community Mental Health Teams in both Adult and Children’s mental health services, advance implementation of Reach Out, our national strategy for Action on Suicide Prevention, and to initiate the provision of psychological and counselling services in primary care, specifically for people with mental health problems. All of these measures will assist in the Government's drive to deal with mental health and suicide.

Reach Out is a comprehensive and integrated approach to reducing the loss and suffering from suicide and suicidal behaviours. It encompasses the promotion, coordination, and support of activities to be implemented at national, regional and community levels. The HSE's National Office for Suicide Prevention (NOSP) is responsible for overseeing the implementation of Reach Out. NOSP has implemented a significant number of the recommendations in a four way strategy - delivering a general population approach to mental health promotion and suicide prevention; using targeted programmes for people at high risk of suicide; delivering services to individuals who have engaged in deliberate self harm and providing support to families and communities bereaved by suicide.

It is widely accepted that suicide is a complex issue and that there are no easy or single interventions that will bring a guarantee of success. International evidence shows that reducing the suicide rate and preventing suicides requires a collective, concerted effort from all groups in society. Solutions, therefore, involve the whole community, a large array of voluntary organisations, specialist mental health professionals and mental healthcare provided by general practitioners and others in primary care. The overall expenditure in time and resources in this area is significant and is always under constant review. I cannot accept that all of these efforts represent failure on the part of any of those involved.